JP4255030B2 - Medical instruments - Google Patents

Description

The present invention relates to a medical instrument.

  There are three types of nutritional administration for patients who cannot take nutrition through the mouth: transvenous nutritional administration, transgastral nutritional administration by inserting a tube through the nose into the stomach, etc., and enteral nutritional administration from the gastrostomy Has been done.

In recent years, enteral nutrition management by percutaneous endoscopic gastrostomy (PEG) has been frequently performed due to the development of enteral nutrition and its administration method. Compared with surgical open gastrostomy, PEG is small invasion and small invasion, and medical costs can be reduced overwhelmingly. Therefore, PEG has become the standard method for gastrostomy in Europe and America. Yes.
In PEG, a through-hole penetrating the patient's abdominal wall and stomach wall is formed prior to construction of the gastrostoma. Prior to the formation of the through-hole, in order to temporarily fix the movable stomach wall, the abdominal wall and the stomach wall are generally sutured with a suture thread.

  As a medical instrument for performing such suturing, for example, a suture insertion puncture needle, a suture grasping puncture needle disposed in parallel therewith, and a slidable within the suture grasping puncture needle There are disclosed a stylet that is inserted, a fixing member that fixes a suture insertion puncture needle and a suture grasping puncture needle at respective proximal ends, and grasps the suture by a stylet. (Patent Document 1).

  The medical instrument described in Patent Document 1 includes (a) a hollow suture insertion puncture needle having an internal passage into which a suture is inserted, and (b) a needle that is arranged in parallel with the needle to grasp the suture. A hollow suture grasping puncture needle used, (c) a stylet slidably inserted into the suture grasping puncture needle, and (d) a suture insertion puncture needle and a suture grasping needle. It consists of a fixing member that fixes the puncture needle at each base end. This stylet has an annular member made of an elastic material that can be accommodated in the internal passage of the suture grasping puncture needle at the tip of the stylet, and the annular member extends from the tip of the suture grasping puncture needle. In the protruded state, the central axis of the suture insertion puncture needle or an extension thereof is configured to extend toward the suture insertion puncture needle so as to pass through the inside of the annular member.

  According to Patent Document 1, this medical instrument is used as follows. First, a living body is punctured by a suture insertion puncture needle and a suture grasping puncture needle. Subsequently, the stylet is inserted from the rear end into the suture grasping puncture needle, and the annular member protrudes from the distal end of the suture grasping puncture needle. Next, the suture is inserted from the rear end of the suture insertion puncture needle. As a result, the suture is exposed from the distal end of the suture insertion puncture needle. In this state, the suture is grasped by the annular member by retracting the stylet in the suture grasping puncture needle. Finally, the suture insertion needle, suture grasping needle and stylet are integrally retracted from the living body, so that one end of the suture is on the side of the suture insertion needle and the other end is the suture. It is pulled out from the holding puncture needle side.

  However, when the medical instrument described in Patent Document 1 is used, the suture is captured by the annular member at the tip of the suture grasping puncture needle. Since the tip is sharp, when the stylet is retracted, if the contact between the suture and the tip of the puncture needle for grasping the suture is performed with an excessively large force, the suture may be cut. .

Moreover, in the medical instrument described in Patent Document 1, two puncture needles had to be punctured simultaneously. For this reason, a more advanced technique is required as compared with the operation of puncturing needles one by one .

  In addition, in order to securely fix the abdominal wall and stomach wall using these medical instruments, it is necessary to repeat the same suturing operation twice, which places a heavy burden on the patient.

  Therefore, Patent Document 2 describes a living body suturing tool for preventing this inconvenience. This biological suturing tool has (a) an internal passage into which a suture is inserted, a hollow fixed puncture needle having a sharp tip, and (b) an internal passage that is arranged in parallel to the suture passage and through which the suture is inserted. (C) a movable outer puncture needle having a sharp tip, and a suture traction tool that can be selectively removed into the inner passage of the outer tube, and a suture traction tool; ) It is configured to include a holder that holds the fixed puncture needle and the outer cylinder in parallel with each other at one position.

  According to Patent Document 2, this biological suturing tool improves the above-described disadvantages. First, the living body is punctured by the fixed puncture needle and the movable puncture needle inserted into the outer cylinder. Subsequently, the movable puncture needle is pulled out from the outer cylinder, the suture traction tool is inserted into the outer cylinder from the rear end, and the snare protrudes from the distal end of the outer cylinder. Next, the suture is inserted from the rear end of the fixed puncture needle, and as a result, the suture is exposed from the front end of the fixed puncture needle. In this state, by retracting the suture traction tool in the outer cylinder, the suture is pulled out of the outer cylinder through the non-sharp tip of the outer cylinder while being held by the snare. At this time, the suture does not need to pass through a sharp portion, so that cutting is prevented.

However, since the suture instrument for living body described in Patent Document 2 passes through the outer cylinder while the suture traction tool holds the suture, the diameter of the outer cylinder is increased. Moreover, even if the movable puncture needle is sharp, there is a possibility that the puncture performance may deteriorate due to the effect of the step portion between the movable puncture needle and the outer cylinder.
Moreover, although the living body suture tool described in Patent Document 2 is not the simultaneous puncture of two needles, the two needles had to be operated simultaneously. For this reason, a more advanced technique is required as compared with the operation of puncturing needles one by one .

  Further, since the puncture needle for inserting a suture and the puncture needle for grasping a suture of the medical instrument of Patent Document 1 and the fixed puncture needle of the suture instrument for living body of Patent Document 2 are both hollow needles, the tip penetrates. There was a tendency for the puncture ability to decrease compared to the needles that were not.

JP-A-4-226663 JP 2003-225240 A

  This invention is made | formed in view of the said situation, The objective is to provide the medical instrument which can improve the workability | operativity and safety at the time of suturing a body surface part and an internal tissue with a suture. .

According to the present invention, (a) a hollow puncture needle having a sharp tip and not penetrating the tip, having a lateral hole near the tip, and a suture thread inserted through the hollow Used thread insertion puncture needle,
(B) a hollow puncture needle that is arranged substantially parallel to the lateral direction of the thread insertion puncture needle, has a sharp tip, and does not penetrate the tip, and has a lateral hole near the tip, A suture grasping needle used by inserting the suture thread into the hollow portion;
(C) a suture traction tool slidably inserted into the hollow portion of the suture grasping puncture needle;
(D) a fixing member that relatively determines the tip positions of the thread insertion puncture needle and the thread grasping puncture needle; and (e) the thread insertion puncture needle and the thread grasping puncture needle that are supported and sutured. A contact member that contacts the object,
And it has a,
A medical instrument is provided in which a cutout portion configured to be able to remove the suture from the heel portion of the contact member is provided in the contact member .

  Further, according to the present invention, there is provided a medical instrument used for suturing a body surface portion and an internal tissue, a main body, a thread insertion puncture needle supported by the main body and capable of inserting a suture thread. A thread grasping puncture needle that is provided in proximity to the thread insertion puncture needle and into which a suture traction tool can be inserted. The thread grasping puncture needle has a sharp tip and a base more than the tip. There is provided a medical instrument characterized in that the suture traction tool can be led out from the opening to the outside of the suture grasping puncture needle. The

  Since the medical instrument of the present invention does not penetrate the tip of the puncture needle, its puncture property can be improved. Further, the hollow portion of the puncture needle communicates with the outside through a horizontal hole or an opening near the tip. For this reason, the suture and the suture traction tool can be reliably led out from the lateral hole in a predetermined direction. Therefore, it is possible to perform a suturing operation with good operability and safety. In addition, the suture insertion needle and the suture grasping needle are supported by the contact member, and the contact member contacts an object to be sutured such as the body surface portion, so that the suturing can be reliably performed.

  In the medical instrument of the present invention, the suture traction tool has a snare whose tip is formed of a material that can be elastically deformed, and in a free state, an extension line of the suture insertion needle is inside the snare. And may be accommodated in the hollow portion of the suture grasping needle in an elastically deformed state. By doing so, the suture can be securely grasped. For this reason, stitching can be performed reliably.

  In the medical instrument of the present invention, the contact member may support the thread insertion puncture needle and the thread grasping puncture needle substantially parallel to each other. By doing so, the stitching can be performed stably.

  In the medical instrument of the present invention, the fixing member is provided on the suture grasping puncture needle, and the distal end position of the suture insertion needle relative to the distal end position of the suture grasping puncture needle is determined at an arbitrary position. It may be configured to be able to. By doing so, the operability during suturing can be further improved.

In the medical instrument of the present invention, the cutout portion may be formed from the collar portion of the abutting member to the holding position of the suture insertion needle . By doing so, it is possible to reliably remove the suture from the contact member in a state where the suture grasping needle is punctured. For this reason, the suturing can be reliably performed by a simple operation.

  In the medical instrument of the present invention, the edge of the horizontal hole of the suture insertion needle and the edge of the lateral hole of the suture grasping needle may be chamfered or rounded. By doing so, breakage of the suture can be suppressed. For this reason, stitching can be performed more reliably.

  In the medical instrument of the present invention, at least one of the thread insertion puncture needle and the thread grasping puncture needle may be detachably supported by the contact member. In this way, the suturing operation can be further simplified.

In the medical instrument of the present invention has a puncture needle for a plurality of said yarn insertion, the yarn grasping needle may be configured to provided close to each of the plurality of the yarn insertion needle Can do. By doing so, the operation of removing the suture insertion needle and the rotating operation of the contact member can be omitted when sewing a plurality of locations. For this reason, it is possible to perform stitching at a plurality of locations more reliably and stably by a simple operation.

According to the present invention, there is provided a medical instrument used for suturing a body surface portion and an internal tissue, a main body, a thread insertion puncture needle supported by the main body and capable of inserting a suture, A thread-gripping puncture needle provided in the vicinity of a thread insertion puncture needle and having a hollow portion into which a suture traction tool can be slidably inserted, and the thread insertion puncture needle and the thread gripping needle A medical instrument is provided in which at least one of the puncture needles is detachably attached to the main body.

In the medical instrument of the present invention, at least one of the suture insertion needle and the suture grasping needle is detachably attached to the main body, so that the suture operation is easy and safe.
In the medical instrument of the present invention, the main body is provided at a rear end of the thread insertion puncture needle or the thread grasping puncture needle, and the distal end of the thread insertion puncture needle or the distal end of the thread grasping puncture needle There may be provided a fixing member for fixing the fixing member at a predetermined position and a supporting member for supporting the fixing member. By doing so, the stitching can be performed stably.

In the medical instrument according to the present invention, the main body further includes an abutting member that abuts the body surface portion on a distal end side of the support member and supports the thread insertion puncture needle and the thread grasping puncture needle. May be. By doing so, the medical instrument can be brought into contact with the body surface portion by the contact member during suturing. For this reason, stitching can be performed more stably. In the medical device of the present invention, the support member supports the fixing member and the contact member, and supports the thread insertion puncture needle and the thread grasping puncture needle through the contact member. It can be configured. By doing so, the suture insertion needle and the suture grasping needle can be supported by the support member via the contact member. For this reason, these puncture needles can be more reliably supported, and the stability during use of the medical instrument can be further improved.

  In the medical instrument of the present invention, the suture grasping needle may be configured such that a guide wire can be further inserted. By doing so, the application range of the medical instrument can be expanded. For example, when a guide wire is used, the insertion path of the catheter can be optimized, and the catheter can be inserted safely and reliably. Furthermore, when a guide wire is used, the guide wire can be inserted simultaneously with the suturing of the body surface part and the internal tissue. Therefore, the catheter insertion path can be optimized after suturing, and the catheter can be inserted safely and reliably. Furthermore, since the number of punctures with the puncture needle until the catheter is inserted can be reduced, the invasion to the patient is very small, and the burden on the patient is small.

  In the medical instrument of the present invention, the guide wire may have an outer diameter of 0.1 mm to 0.8 mm.

In the medical instrument of the present invention, the fixing member may have a notch portion that allows the thread insertion puncture needle or the thread grasping puncture needle to be detachable from the main body. By doing so, it is possible to reliably attach and detach the suture insertion needle or the suture grasping needle.
In the medical instrument of the present invention, the contact member may have a notch portion that allows the thread insertion puncture needle or the thread grasping puncture needle to be detachable from the main body. By doing so, the insertion / removal of the suture insertion needle or the suture grasping needle can be easily and reliably performed.

  In the medical instrument of the present invention, the thread insertion puncture needle and the thread grasping puncture needle may be configured to be puncturable independently. In this way, two puncture needles can be operated one by one without simultaneous puncture or simultaneous operation of the two puncture needles. For this reason, operability is good and safe operation is possible. In addition, the stress on the operator can be reduced and the operation time can be shortened. Therefore, workability and safety when the body surface part and the internal tissue are sutured with the suture can be improved.

  In the medical instrument of the present invention, the thread insertion puncture needle is removed in a state where the thread insertion puncture needle and the thread grasping puncture needle are punctured and the main body is in contact with the body surface portion. It may be configured to be able to. By doing so, the suture insertion needle can be removed while holding the suture with the suture grasping needle. For this reason, a plurality of places can be stitched by a series of operations.

In the medical instrument of the present invention, the main body may be configured to be rotatable about the thread grasping puncture needle as a rotation axis. By doing so, stitching at a plurality of locations can be performed reliably.
The medical instrument of the present invention has a plurality of the thread insertion puncture needles, and the thread grasping puncture needles are provided in proximity to each of the plurality of thread insertion puncture needles. it can. By doing so, it is possible to omit the operation of removing the thread insertion puncture needle and the operation of rotating the main body. For this reason, it is possible to perform stitching at a plurality of locations more reliably and stably by a simple operation.

It should be noted that any combination of these components, or a conversion of the expression of the present invention between a method, an apparatus, and the like is also effective as an aspect of the present invention.
For example, according to the present invention, a suturing method using a medical instrument including the following steps is provided.
(I) A step of penetrating the suture grasping needle through the body surface and internal tissue (ii) A suture traction tool is inserted into the hollow portion of the suture grasping needle, and the suture is pulled outside the suture grasping needle. (Iii) step of piercing the body surface part and internal tissue with the thread insertion puncture needle (iv) inserting the suture thread into the hollow portion of the thread insertion puncture needle, and Step (v) for deriving the suture (v) Step for grasping the derived suture with the suture traction tool led to the outside of the suture grasping needle (vi) Pulling the suture traction tool while grasping the suture And pulling the suture to the suture grasping needle and holding the suture in the vicinity of the suture grasping needle (vii) while holding the suture in the vicinity of the suture grasping needle, The suture thread is pulled out of the body surface and internal tissue. -Up.
According to the suturing method of the present invention, the body surface part and the internal tissue can be reliably sewn with a simple operation.

  In the suturing method, in the step (vii), the suture traction tool can be pulled out first, and then the suture grasping needle can be pulled out.

In the suturing method of the present invention, after the step of holding the suture in the vicinity of the suture grasping needle, the suture insertion needle is pulled out with the suture grasping needle penetrating the body surface and the internal tissue. Then, a step of rotating the main body around the suture grasping needle as an axis may be included. In the suturing method of the present invention, after the step of rotating the main body, a step of penetrating the body surface portion and the internal tissue with the suture insertion needle may be included again.
By doing so, it is possible to puncture the thread insertion puncture needles at a plurality of locations on the concentric circle with the thread grasping puncture needle as the rotation axis. For this reason, stitching can be performed reliably at a plurality of locations. In addition, the number of punctures of the puncture needle from the stitching of a plurality of scheduled stitching sites separated from each other to the insertion of the catheter can be reduced.

The above-described object and other objects, features, and advantages will become more apparent from the preferred embodiments described below and the accompanying drawings.
FIG. 1 is a front sectional view showing a medical instrument according to the present embodiment.
FIG. 2 a is a front sectional view showing the configuration of the puncture needle for grasping a thread of the medical instrument according to the present embodiment.
FIG. 2B is a cross-sectional view showing the configuration of the suture traction tool of the medical instrument according to the present embodiment.
FIG. 2c is a front cross-sectional view showing a configuration combining FIG. 2a and FIG. 2b.
FIG. 3 is a front sectional view of the suture insertion needle of the medical instrument according to the present embodiment.
FIG. 4 is a front cross-sectional view showing the needle tip of the suture grasping needle of the medical instrument according to the present embodiment.
FIG. 5 is a view illustrating a front surface and a plane surface of the contact member of the medical instrument according to the present embodiment.
FIG. 6 is a diagram illustrating the procedure for using the medical instrument according to the present embodiment.
FIG. 7 is a front sectional view showing Step 1 of the method of using the medical instrument of FIG.
FIG. 8 is a front sectional view showing Step 2 of the method for using the medical instrument of FIG.
FIG. 9 is a front sectional view showing Step 3 of the method of using the medical instrument of FIG.
FIG. 10 is a front sectional view showing Step 4 of the method of using the medical instrument of FIG.
FIG. 11 is a front sectional view showing step 5 of the method for using the medical instrument of FIG.
FIG. 12 is a front sectional view showing Step 6 of the method for using the medical instrument of FIG.
FIG. 13 is a front sectional view showing Step 7 of the method of using the medical instrument of FIG.
FIG. 14 is a front sectional view showing Step 8 of the method for using the medical instrument of FIG.
FIG. 15 is a front sectional view showing Step 9 of the method for using the medical instrument of FIG.
FIG. 16 is a front sectional view showing step 10 of the method of using the medical instrument of FIG.
FIG. 17 is a perspective view showing the configuration of the medical instrument according to the present embodiment.
FIG. 18 is a front view showing the configuration of the main body of the medical instrument according to the present embodiment.
FIG. 19 is a diagram showing a front view and a cross section of a puncture needle for thread insertion of the medical instrument according to the present embodiment.
FIG. 20 is a view showing a front and a cross section of a puncture needle for grasping a thread of the medical instrument according to the present embodiment.
FIG. 21 is a front view showing the suture traction tool of the medical instrument according to the present embodiment.
FIG. 22 is a front cross-sectional view showing a state where the contact member of the medical device according to the present embodiment is in contact with the abdominal wall and punctured perpendicularly to the suture grasping needle.
FIG. 23 is a front cross-sectional view showing a state in which the suture traction tool of the medical instrument according to the present embodiment is inserted into the suture grasping needle.
FIG. 24 is a front cross-sectional view showing a state where a suture insertion needle is punctured inside the annular portion of the suture traction tool of the medical instrument according to the present embodiment.
FIG. 25 is a front cross-sectional view showing a state in which the suture thread is projected from the tip of the suture insertion needle of the medical instrument according to the present embodiment.
FIG. 26 is a front cross-sectional view showing a state where the thread insertion puncture needle of the medical instrument according to the present embodiment is pulled out.
FIG. 27 is a front cross-sectional view showing a state in which the main body is rotated approximately 180 ° with the suture grasping needle of the medical device according to the present embodiment as a rotation axis.
FIG. 28 is a front cross-sectional view showing a state in which the suture insertion needle of the medical instrument according to the present embodiment is punctured again and a suture is inserted.
FIG. 29 is a front sectional view showing a state where the suture traction tool of the medical instrument according to the present embodiment is pulled up and the suture is gripped by the annular portion.
FIG. 30 is a front sectional view showing a state in which the guide wire of the medical instrument according to the present embodiment is inserted.
FIG. 31 shows that the suture thread inserted from two positions where the suture insertion needle of the medical instrument according to the present embodiment has been pierced passes through the stomach wall from the abdominal wall and protrudes from the position where the suture grasping needle has been punctured. It is front sectional drawing which shows the state which carried out.
FIG. 32 is a perspective view showing the configuration of the medical instrument according to the present embodiment.
FIG. 33 is a front view showing the configuration of the main body of the medical instrument according to the present embodiment.
FIG. 34 is a diagram showing a front view and a cross-section of the suture insertion needle of the medical instrument according to the present embodiment.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings. The medical instrument described below is a medical suturing fixture used for suturing a body surface part and internal tissue. Specifically, this medical suturing / fixing device is used for facilitating the insertion of a catheter, for example, during percutaneous endoscopic gastrostomy for the purpose of replenishing nutrients and discharging body fluids. Used to fix the abdominal wall and stomach wall. 1 to 5 and FIGS. 7 to 34, the upper side of the figure is the proximal end (rear end) side of the needle, and the lower side of the figure is the distal end side of the needle.

(First embodiment)
FIG. 1 is a cross-sectional view illustrating a configuration of a medical instrument according to the present embodiment. The medical instrument shown in FIG. 1 is a combination of a suture grasping needle 701, a guide member 706, a fixing member 708, a suture traction tool 710, a suture insertion puncture needle 715, and a contact member 722. It is a configuration. This medical instrument can be used, for example, as a stomach wall abdominal wall fixture.

  2a to 2c are diagrams showing configurations of the suture grasping needle 701 and its peripheral members. FIG. 2 a is a cross-sectional view showing a state in which the suture grasping needle 701 is combined with the guide member 706 and the fixing member 708. FIG. 2 b is a cross-sectional view showing the configuration of the suture traction tool 710. Moreover, FIG. 2c is sectional drawing which shows the state which combined FIG. 2a and 2b.

  As shown in FIGS. 2a to 2c, the rod 711 and the snare 712 of the suture traction tool 710 are configured to be housed in the hollow portion 703 of the suture grasping needle 701. By sliding the slide member 713 along the guide member 706, the suture traction tool 710 slides in the hollow portion 703, and the snare 712 provided at the distal end of the suture traction tool 710 is inserted into the suture grasping needle 701. The horizontal hole 704 can be led out of the hollow portion 703.

  FIG. 4 is an enlarged view of the cross-section of the needle tip of the suture grasping needle 701. The suture grasping needle 701 is a hollow needle-like member made of metal and has a sharp tip 702. Since it has a sharp tip 702, the skin can be easily punctured. Further, the suture grasping needle 701 has a configuration in which a hollow portion 703 formed therein does not penetrate the tip 702. The hollow portion 703 has a structure that communicates with the outside through a lateral hole 704 provided near the tip 702. Within this hollow portion 703, the suture traction tool 710 can slide. Specifically, the outer diameter of the suture grasping needle 701 can be, for example, 12G to 22G, preferably 19G to 21G. Further, when a guide wire is inserted into the hollow portion 703, the outer diameter of the suture grasping needle 701 can be set to, for example, 16G or more and 18G or less. By doing so, the suture traction tool and the guide wire can be easily and simultaneously inserted into the suture grasping needle 701, and the guide wire can be suitably inserted into the living body together with the suture.

  The total length of the suture grasping needle 701 is not particularly limited, but may be, for example, 20 mm or more and 200 mm or less, preferably 80 mm or more and 100 mm or less. If the overall length is too short, the thread grasping puncture needle 701 may be buried in the patient's abdominal wall, and if it is too long, the operability of the medical instrument may be reduced.

  In the suture grasping needle 701, a portion that may come into contact with the suture during suturing may be configured to be not sharp. In particular, as will be described later, the lateral hole 704 in which the suture can be brought into contact with the suture when the suture is grasped by the suture traction tool 710 and pulled toward and held by the suture grasping needle 701 is configured not to be sharp. ing. Specifically, for example, chamfering processing of the C surface or the R surface can be performed on the edge of the horizontal hole 704.

  Further, the hollow portion 703 extending from the rear end of the suture grasping needle 701 to the lateral hole 704 can be configured to have no step. By doing so, when the suture traction tool 710 slides in the hollow portion 703, the snare 712 can slide smoothly without being caught. Specifically, for example, the central axis of the horizontal hole 704 has an inclination of 120 to 150 degrees with respect to the central axis of the suture grasping needle 701 at the portion of the hollow portion 703 that continues to the horizontal hole 704. it can.

  The guide material 706 is attached to the rear end of the thread grasping puncture needle 701 in a direction opposite to the extending direction of the thread grasping puncture needle 701. The guide member 706 is slidably fitted to a slide member 713 attached to the rear end of the suture traction tool 710 described later. When the shoulder surface 714 of the slide material 713 is brought into contact with the shoulder surface 707 of the guide material 706, the suture traction tool 710 slides in the hollow portion 703 of the suture grasping needle 701, and the advance limit is reached. It has a function to guide what has been reached.

  Further, since the guide member 706 and the slide member 713 are fitted in only one direction, when the suture traction tool 710 slides in the hollow portion 703 of the suture grasping needle 701 and reaches the advance limit, The snare 712 of the suture traction tool 710 can be surely expanded in the direction of the suture insertion needle 715.

  The fixing member 708 is attached to the rear end of the suture grasping needle 701. The fixing member 708 has a shape in which the shoulder surface 709 fits only to a shoulder surface of a stopper (not shown) of a thread insertion puncture needle 715, which will be described later, in a fixed direction so as not to be relatively rotatable. As a result, the lateral hole (not shown) of the thread insertion puncture needle 715 can be reliably disposed on the thread grasping puncture needle 701 side. Further, by this fitting, the tip (not shown) of the thread insertion puncture needle 715 can be determined at a single position forward relative to the position of the tip 702 of the thread grasping puncture needle 701.

  The suture traction tool 710 includes a rod 711, a snare 712 attached to the tip of the rod 711, and a slide material 713 attached to the rear end. The rod 711 can be made of metal. The snare 712 is made of an elastically deformable material.

  The snare 712 is annular in a free state, and when it is housed in the hollow portion 703 of the suture grasping needle 701, it is elastically deformed linearly. As a result, the snare 712 becomes an annular body when pushed out from the lateral hole 704 to the outside of the thread grasping puncture needle 701, so that the portion exposed from the distal end side of the suture insertion needle 715 for suture (not shown) Can be easily captured.

  As described above, the slide member 713 attached to the rear end of the suture traction tool 710 is slidably fitted to the guide member 706 attached to the rear end of the suture grasping needle 701, and the guide member 706 is fitted. By bringing the shoulder surface 714 of the slide member 713 into contact with the shoulder surface 707, the suture traction tool 710 has a function of guiding that the advance limit in the hollow portion 703 of the suture grasping needle 701 has been reached.

  FIG. 3 is a cross-sectional view showing a configuration of the suture insertion needle 715. The shape of the suture insertion needle 715 can be the same as that of the suture grasping needle 701 shown in FIG. The thread insertion puncture needle 715 is hollow and formed of metal, and has a sharp tip 716. Since it has a sharp tip 716, the skin can be punctured easily. Further, the hollow portion 717 formed inside the suture insertion needle 715 does not penetrate the tip 716. The hollow portion 717 has a structure that communicates with the outside through a lateral hole 718 provided near the tip 716. A suture can be inserted into the hollow portion 717.

  Specifically, the outer diameter of the suture insertion needle 715 can be, for example, 15G or more and 25G or less, preferably 19G or more and 21G or less. By doing so, the puncture resistance of the puncture needle 715 for inserting a thread can be reduced, and puncture into the body is easy.

  The total length of the suture insertion needle 715 is not particularly limited, but may be, for example, 20 mm to 200 mm, preferably 80 mm to 100 mm. If the total length is too short, it may be buried in the patient's abdominal wall, and if it is too long, the operability of the medical instrument may be reduced.

  In the thread insertion puncture needle 715, a portion that may come into contact with the suture can be configured to be not sharp. In particular, the lateral hole 718 of the puncture needle 715 for thread insertion, which will come into contact when the suture is grasped by the suture traction tool 710 and pulled toward the suture grasping needle 701, is made not sharp. Specifically, for example, chamfering of the C surface or the R surface can be performed on the edge of the horizontal hole 718.

  Furthermore, it is preferable that the hollow portion 717 that continues from the rear end of the suture insertion needle 715 to the lateral hole 718 has no step and can smoothly insert the suture. Specifically, the central axis of the lateral hole 718 can be configured to have an inclination of 120 to 150 degrees with respect to the central axis of the thread insertion puncture needle 715 in the portion continuing to the lateral hole 718 of the hollow portion 717.

A stopper 719 is attached to the rear end of the suture insertion needle 715. As described above, the stopper 719 is fitted to the shoulder surface 709 of the fixing member 708 attached to the rear end of the suture grasping needle 701 only in one direction so as not to be relatively rotatable. As a result, the lateral hole 718 of the thread insertion puncture needle 715 can be surely oriented in the direction of the thread gripping puncture needle 701, and the fitting allows the distal end 716 of the thread insertion puncture needle 715 to move toward the end. With respect to the position of the tip 702 of the suture grasping needle 701, it is possible to determine only one position forward.

  The stopper 719 has a tapered hole 721 for inserting a suture thread. The larger diameter side of the taper hole 721 is larger than the inner diameter of the thread insertion puncture needle 715, and the diameter decreases toward the thread insertion puncture needle 715. The smaller diameter side of the taper hole 721 is substantially for thread insertion. The inner diameter of the puncture needle 715 is made equal. Thereby, it can be set as the structure which does not have a level | step difference between this taper hole 721 and the inner side of the puncture needle 715 for thread | yarn insertion. For this reason, it is possible to insert a smooth suture thread (not shown) from the rear end of the suture insertion needle 715.

  FIG. 5 is a view showing the front and plane of the contact member 722. The contact member 722 is a holder that holds the suture grasping needle 701 and the suture insertion puncture needle 715 at a constant interval and in parallel with each other. As will be described later, the abutting member 722 abuts on an object to be sutured such as a body surface during suturing. For this reason, the medical instrument can be held on the object to be sutured during suturing. Therefore, the suturing can be reliably performed. The thread grasping puncture needle 701 and the thread insertion puncture needle 715 can slide independently of each other in the contact member 722.

  A notch 723 is provided on the side of the contact member 722 where the suture insertion needle 715 is located. The width of the portion of the notch 723 that is in contact with the suture insertion needle 715 is, for example, about φ0.25 to 0.5 mm. In this manner, the suture thread 705 is removed from the notch 723 in a state where the suture insertion needle 715 is removed from the contact member 722, and the contact member 722 can be easily used with the suture grasping needle 701 as the rotation axis. Can be rotated. In addition, with such a configuration, as will be described later, the planned suture site is a puncture position of the puncture needle 701 for grasping a thread as one end, and a plurality of puncture positions of the puncture needle 715 for thread insertion are centered on this position. It can be arranged concentrically.

  The material of the contact member 722 can be, for example, a highly transparent synthetic resin material. Since the abutting member 722 is installed on a site where a small incision is made in the abdomen with a scalpel in the usage method described later, the suturing operation can be performed more reliably by using a transparent material.

  As described above, in the present embodiment, the thread insertion puncture needle 715 and the thread grasping puncture needle 701 having high puncture properties and the contact member 722 that improves usability without puncturing these puncture needles simultaneously are provided. Further, it is possible to stably provide a medical instrument in which a plurality of suture sites are arranged concentrically. For this reason, in the percutaneous endoscopic gastrostomy, it is possible to improve the performance of the medical instrument for suturing the abdominal wall and the stomach wall with the suture thread.

Next, an actual method of using the medical instrument according to the present invention will be described to clarify the effects of the present invention.
FIG. 6 is a flowchart illustrating a method of using the medical instrument of the present embodiment. 7-16 is a figure explaining each procedure of step 1-step 10 shown in FIG.

  The medical instrument according to the present embodiment is used for suturing a plurality of predetermined suture sites separated from each other with a suture thread in a living body. Before using the medical instrument according to the present embodiment, an endoscope is first inserted into the stomach of the patient, air is sufficiently supplied, and the inner side of the abdomen and the outer wall of the stomach are brought into close contact with each other. Next, the position of the stomach is confirmed by transmitted light from the endoscope, the abdominal skin is disinfected, and local anesthesia is performed. Subsequently, a small incision is made at the site with a scalpel.

  First, in step 1, the contact member 722 of the present invention is placed on the small incision site of the abdominal wall 100 (FIG. 7).

  Next, in step 2, the puncture needle 701 for grasping a thread of the present invention is punctured perpendicularly to the abdominal wall 100 and stomach wall 101 of the patient through the contact member 722 (FIG. 8). At this time, the suture traction tool 710 is already stored in the hollow portion 703 of the suture grasping needle 701, and the snare 712 is in a state of being elastically deformed linearly.

Subsequently, in step 3, the shoulder surface 714 of the slide member 713 attached to the rear end of the thread grasping puncture needle 701 is slid until it comes into contact with the shoulder surface 707 of the guide member 706 of the thread grasping puncture needle 701 ( FIG. 9). As a result, the snare 712 of the suture traction tool 710 protrudes from the lateral hole 704 in the direction in which the suture grasping needle 701 can be punctured to form a free ring.
Subsequently, in step 4, the thread insertion puncture needle 715 is punctured perpendicularly to the abdominal wall 100 and stomach wall 101 of the patient through the contact member 722 in the same manner as the thread grasping puncture needle 701 (FIG. 10). At this time, it is confirmed by an endoscope that the thread insertion puncture needle 715 is passing through the inside of the annular snare 712 of the suture traction tool 710.

  In this embodiment, both the thread grasping puncture needle 701 and the thread insertion puncture needle 715 are puncture needles having a sharp tip that does not penetrate the tip. For this reason, compared with the case of using a puncture needle with steps such as a hollow needle, a cannula, an outer cylinder, etc., the puncture property is very high and a living body can be punctured easily. Further, in the present embodiment, since the thread grasping puncture needle 701 and the thread insertion puncture needle 715 are operated one by one, two thread puncture needles 701 and the thread insertion puncture needle 715 are simultaneously punctured, or Compared to two simultaneous operations, the function of easily puncturing a living body is achieved without requiring force, experience, or skill.

  Subsequently, in Step 5, the suture thread 705 is pushed in from the rear end of the suture insertion needle 715, and the end portion of the suture thread 705 is exposed from the lateral hole 718 of the suture insertion needle 715 (FIG. 11). In this state, since the thread insertion puncture needle 715 itself passes through the inside of the snare 712 forming the ring shape of the suture traction tool 710, the suture thread 705 led out from the thread insertion puncture needle 715 is also included in the snare 712. It passes inside.

  Subsequently, in Step 6, only the suture thread 705 is left as it is, and only the suture insertion needle 715 is removed from the living body and the contact member 722 (FIG. 12). As a result, the suture thread 705 passes through the inside of the snare 712. At this time, the suture thread 705 may be caught by the snare 712 once.

  From this point, if the operator decides to finish only one planned suture site, the process proceeds to step 7. Further, when the planned suture site is one end of the puncture position of the thread grasping puncture needle 701 and a plurality of puncture positions of the thread insertion puncture needle 715 are arranged concentrically around the puncture position, the process proceeds to step 9.

  First, when there is only one planned suture site and the suture is finished at one location, in step 7, the slide material 713 of the suture traction tool 710 is moved along the guide material 706 of the suture grasping needle 701. By sliding upward, the snare 712 of the suture traction tool 710 is inserted into the hollow portion 703 from the lateral hole 704 of the suture grasping needle 701 (FIG. 13). Along with this, the snare 712 that has formed an annular shape is elastically deformed and gradually linearized, and the suture 705 is gripped by the snare 712 at the side hole 704 portion of the suture grasping needle 701.

  In this state, since the edge of the horizontal hole 704 is chamfered on the C surface or the R surface, the suture 705 held by the snare 712 needs to contact the horizontal hole 704 of the suture grasping needle 701 more than necessary. The cutting of the suture thread 705 due to being performed with a large force is prevented.

  Subsequently, in Step 8, the contact member 722 including the suture grasping needle 701 and the suture traction tool 710 is pulled away from the patient's abdomen (FIG. 14). Along with this, the suture 705 held by the snare 712 of the suture traction tool 710 is also pulled out of the body. As a result, the suture thread 705 enters the body from the position where the suture insertion needle 715 has been punctured, passes through the stomach, and is exposed outside the body from the position where the suture grasping needle 701 has been punctured. Become.

Then, if each end part of the exposed suture 705 is ligated using a ligation tool, the stomach wall 101 and the abdominal wall 100 will be fixed by the suture 705.
Further, when the planned suture site is arranged with the puncture position of the suture grasping needle 701 as one end and a plurality of puncture positions of the thread insertion puncture needle 715 are arranged concentrically around this, the process proceeds from step 5 to step 9.

  In step 9, the suture thread 705 is removed from the contact member 722 from the notch 723 of the contact member 722 outside the body while maintaining the state where the suture thread 705 passes inside the snare 712 inside the body. (FIG. 15). Since the notch 723 is provided in the contact member 722, the suture 705 can be reliably removed from the contact member 722 in a state where the suture grasping needle 701 is fixed to the contact member 722.

  Subsequently, in step 10, the contact member 722 is rotated around the puncture position of the thread grasping puncture needle 701 toward the scheduled puncture position of the next thread insertion puncture needle 715 (FIG. 16). This rotation can be 360 degrees.

  Subsequently, as Step 11, similarly to the case where only one scheduled suture site is completed, Step 4 to Step 4 are performed to puncture the insertion needle 715 perpendicularly to the abdominal wall 100 and stomach wall 101 of the patient through the contact member 722. Repeat 6 until the planned number of stitches.

  Finally, in step 12, as in the case where only one scheduled suture site is completed, the suture thread 705 is held by the snare 712 at the side hole 704 portion of the suture grasping needle 701. And step 8 is performed.

  By doing so, the puncture position of the suture grasping needle 701 at one end of the planned suture site is realized as one end, and a plurality of puncture positions of the thread insertion puncture needle 715 are arranged concentrically around the puncture position. The stomach wall 101 and the abdominal wall 100 are fixed by the thread 705.

  By rotating the contact member 722 in a state where the suture grasping puncture needle 701 is punctured, the puncture position of the suture insertion needle 715 can be adjusted. For this reason, the gastric wall 101 and the abdominal wall 100 can be reliably fixed at a plurality of locations on an arc centered on the suture grasping needle 701 with a simple operation.

Thus, a series of suturing operations using the medical instrument according to the present embodiment is completed.
In the present embodiment, puncture needles having a sharp tip that does not penetrate the tip are used as the suture grasping needle 701 and the suture insertion puncture needle 715. For this reason, compared with the case of using a puncture needle with steps such as a hollow needle, a cannula, an outer cylinder, etc., the puncture property is very high and a living body can be punctured easily.

  In addition, one thread holding puncture needle 701 and one thread insertion puncture needle 715 are each operated. For this reason, compared with the conventional method which requires two simultaneous punctures of the thread grasping puncture needle and the thread insertion puncture needle or simultaneous operation of the two, it does not require force, experience or technique, and the operator's stress. Reduction and shortening of operation time are possible.

  Further, with the puncture position of the thread grasping puncture needle 701 as one end, a plurality of puncture positions of the thread insertion puncture needle 715 can be arranged concentrically around the puncture position as a center. For this reason, the planned stitching site can be fixed safely and reliably. Furthermore, since the patient is not very invasive due to this fixation, and the burden on the patient is small, the patient can be returned to the society early and medical costs can be reduced.

  The medical instrument shown in the following embodiment is configured using a thread insertion puncture needle (first puncture needle) 3 and a thread grasping puncture needle (second puncture needle) 4.

(Second embodiment)
FIG. 17 is a perspective view showing the configuration of the medical instrument according to the present embodiment.
A medical device 1 shown in FIG. 17 includes a main body 2, a thread insertion puncture needle 3 supported by the main body 2 and capable of inserting a suture thread, and a suture thread provided close to the thread insertion puncture needle 3. It is comprised with the puncture needle 4 for thread | gripping which can insert a traction tool. The thread insertion puncture needle 3 and the thread grasping puncture needle 4 are detachably attached to the main body 2 by an attaching / detaching means.

  In the present embodiment and the third embodiment, the thread insertion puncture needle 3 corresponds to the thread insertion puncture needle 715 in the medical instrument (FIG. 1) described in the first embodiment. The thread grasping puncture needle 4 corresponds to the thread grasping puncture needle 701 in the medical instrument (FIG. 1) described in the first embodiment.

Hereinafter, each component will be described.
FIG. 18 is a front view showing the configuration of the main body 2 of the medical instrument 1. The main body 2 has a function of supporting the suture insertion needle 3 and the suture grasping needle 4.

  The main body 2 has a support member 21, a fixing member 22 provided on the base end side (upper side in FIG. 17) of the support member 21, and a contact member 23 provided on the distal end (lower side in FIG. 17). is doing.

  In the present embodiment and the third embodiment, the contact member 23 corresponds to the contact member 722 in the medical instrument (FIG. 1) described in the first embodiment. The fixing member 22 corresponds to the fixing member 708 in the medical instrument (FIG. 1) described in the first embodiment.

  The support member 21 has a U shape and supports the fixing member 22 and the contact member 23. The thread insertion puncture needle 3 and the thread grasping puncture needle 4 are supported by the support member 21 via the contact member 23. Examples of the material constituting the support member 21 include materials such as vinyl chloride resin, polycarbonate resin, ABS resin, polyacetal resin, polyamide resin, polypropylene resin, polyethylene resin, and metals such as stainless steel.

  The fixing member 22 has a function of fixing the suture insertion needle 3 and the suture grasping needle 4. As shown in FIG. 18, the fixing member 22 includes a first fixing portion 221 and a second fixing portion 222 for fixing the thread insertion puncture needle 3 and the thread grasping puncture needle 4, respectively, and a plate-like body 223. And these are integrally formed.

  The first fixing portion 221 and the second fixing portion 222 are provided on the base end side (upper side in FIG. 18) of the plate-like body 223. The first fixing portion 221 and the second fixing portion 222 are provided so as to be symmetric with respect to the support member 21.

  The 1st fixing | fixed part 221 and the 2nd fixing | fixed part 222 have the substantially same structure, and each shape is a substantially rectangular parallelepiped. Further, the height of the first fixing portion 221 is higher than that of the second fixing portion 222. Accordingly, the user can easily identify the first fixing portion 221 and the second fixing portion 222 visually. In addition, in this embodiment, although the height of the 1st fixing | fixed part 221 and the 2nd fixing | fixed part 222 differs, these heights may be the same.

The first fixing portion 221 is provided with a first recess 224 into which the thread insertion puncture needle 3 can be inserted.
The first concave portion 224 has a first flange engagement with a first flange (not shown in FIGS. 17 and 18) of the first hub 31 (described later) provided on the puncture needle 3 for thread insertion. A joint portion 225 is formed.

The first recess 224 is hollowed out in a columnar shape, and has a small diameter on the distal end side and a large diameter on the proximal end side with the first flange engaging portion 225 as a boundary.
The first concave portion 224 is open to the front side of the first fixing portion 221, and a first hub 31 of a thread insertion puncture needle 3 to be described later can be inserted from the front side portion.

  A first flange (not shown in FIGS. 17 and 18) can engage with the first flange engaging portion 225. When the first flange (not shown in FIGS. 17 and 18) is engaged with the first flange engaging portion 225, the thread insertion needle 3 does not rotate or move up and down.

Further, the thread insertion puncture needle 3 is inserted into the first recess 224 from the proximal end side without engaging the first flange (not shown in FIGS. 17 and 18) with the first flange engaging portion 225. It can also be inserted. Also in this case, the outer periphery of the first flange (not shown in FIGS. 17 and 18) fits and is fixed in the first recess 224, so that the rotation does not move up and down.
In addition, the second fixing portion 222 is provided with a second recess 226 into which the suture grasping needle 4 can be inserted.

The second recess 226 has a second flange engagement with a second flange (not shown in FIGS. 17 and 18) of a second hub 41 (described later) provided on the suture grasping needle 4. A joint portion 227 is formed.
The second concave portion 226 is hollowed out in a columnar shape, and has a small diameter on the distal end side and a large diameter on the proximal end side with the second flange engaging portion 227 as a boundary.
The second concave portion 226 is opened to the front side of the second fixing portion 222, and a second hub 41 of the suture grasping needle 4 described later can be inserted from the front side portion.

  The first fixing portion 221 and the second fixing portion 222 have a first notch 2213 and a second notch 2223, respectively, so that the thread insertion puncture needle 3 and the thread grasping puncture needle 4 can be attached and detached. Is formed. Thereby, the thread insertion puncture needle 3 and the thread grasping puncture needle 4 can be made detachable. Therefore, workability can be improved and stitching can be reliably performed with a simple operation.

  The first notch 2213 and the second notch 2223 are respectively connected to the first recess 224 and the second notch 2 through the first fixing part 221 and the second fixing part 222 from the front side edge of the fixing member 22. It is formed up to the inside of the recess 226.

The fixing member 22 is provided with a sliding portion 229 that allows the fixing member 22 to slide with respect to the support member 21. As a result, the fixing member 22 can move forward and backward with respect to the support member 21, and puncturing with the thread insertion puncture needle 3 and the thread grasping puncture needle 4 is facilitated.
The fixing member 22 is preferably made of a highly transparent resin material because it is installed on a part where a small incision is made with a scalpel in a body surface part such as the abdomen, for a usage method described later.

The contact member 23 has a function of improving stability when the medical device 1 is used by contacting the body surface portion.
As shown in FIGS. 17 and 18, the contact member 23 has a flat plate shape, and has a first cylindrical portion 231 having a lumen into which the thread insertion puncture needle 3 can be inserted on the proximal end surface. A second cylindrical portion 232 having a lumen into which the suture grasping needle 4 can be inserted is provided.

  The first cylindrical portion 231 and the second cylindrical portion 232 have a function of improving stability when puncturing the thread insertion puncture needle 3 and the thread grasping puncture needle 4, respectively.

  The contact member 23 includes a first notch 233 and a second notch as attachment / detachment means so that the thread insertion puncture needle 3 and the thread grasping puncture needle 4 can be attached to and detached from the contact member 23. 234 is provided. Thereby, the contact member 23 can detachably hold the suture insertion needle 3 and the suture grasping needle 4. Therefore, workability can be improved.

  The first notch 233 and the second notch 234 are formed from the flange portion of the contact member 23 to the inside of the cylinder via the first cylinder part 231 and the second cylinder part 232, respectively. Thereby, the suture insertion needle 3 and the suture grasping needle 4 can be attached to and detached from the contact member 23.

  Further, the contact member 23 is provided with two convex portions 235 having a concave portion into which one end of the support member 21 can be inserted at the center. One end of the support member 21 is inserted into the concave portion of the convex portion 235.

FIG. 19 is a diagram showing a front view and a cross section of the suture insertion needle 3 for inserting a thread. The suture insertion needle 3 has a function of inserting a suture into the internal tissue.
As shown in FIG. 19, the suture insertion needle 3 has a first hub 31 provided on the proximal end side (upper side in FIG. 19) and a first needle portion 32 provided on the distal end side. is doing. The first hub 31 and the first needle portion 32 have a hollow portion 33 and are used as a passage for suture thread.
In the present embodiment and the third embodiment, the first hub 31 corresponds to the stopper 719 (FIG. 3) in the medical instrument described in the first embodiment.

  The first hub 31 has a substantially cylindrical shape, and has a first flange 311 that can be engaged with the first flange engaging portion 225 on the distal end side thereof. Further, the hollow portion 33 in the first hub 31 has an inner diameter that gradually decreases from the proximal end side toward the distal end side.

  The first needle portion 32 has an opening communicating with the hollow portion 33 on the distal end side (lower side in FIG. 19). The first needle portion 32 maintains a constant outer diameter from the proximal end to the vicinity of the distal end, and a sharp needle tip is formed at the tip.

  In the present embodiment and the third embodiment, the shape of the first needle portion 32 can be, for example, the shape of the suture insertion needle 715 in the first embodiment (FIG. 4). By doing so, the first needle portion 32 can be configured such that the lateral hole communicating with the outside faces the second needle portion 42 reliably. In addition, the suture can be inserted smoothly.

  Although the outer diameter of the 1st needle part 32 is not specifically limited, For example, it is 15G or more and 25G or less, Preferably it can be 19G or more and 21G or less. In this way, the puncture resistance of the thread insertion puncture needle 3 can be reduced, and puncture into the body is easy.

  Although the full length of the 1st needle part 32 is not specifically limited, For example, it is 20 mm or more and 200 mm or less, Preferably it can be 80 mm or more and 100 mm or less. If the total length is too short, it may be buried in the patient's abdominal wall, and if it is too long, the operability of the medical instrument may be reduced.

FIG. 20 is a view showing a front surface and a cross section of the suture grasping needle 4. The suture grasping needle 4 has a function of inserting a suture traction tool into the internal tissue. Furthermore, by forming a space in which the guide wire can be inserted, the guide wire can be inserted into the living body together with the suture thread. The position where the guide wire is inserted can function as a catheter insertion position.

  As shown in FIG. 20, the suture grasping needle 4 has a second hub 41 provided on the proximal end side (upper side in FIG. 20) and a second needle portion 42 provided on the distal end side. is doing. The second hub 41 and the second needle portion 42 have a hollow portion 43 and are used as a passage for a suture traction tool. Furthermore, it can also be used as a guide wire passage to be described later.

  The second hub 41 has a substantially cylindrical shape, and a second flange 411 that engages with the second flange engaging portion 227 on the distal end side, and a handle portion 51 of the suture traction tool 5 on the proximal end side. And an abutting portion 412 that abuts. The hollow portion 43 in the second hub 41 has an inner diameter that gradually decreases from the proximal end side toward the distal end side.

  A side port 413 into which a guide wire can be inserted is provided on the side portion of the second hub 41. The outer diameter of the guide wire is not particularly limited, but may be, for example, 0.1 mm to 0.8 mm, preferably 0.4 mm to 0.6 mm. If the outer diameter is too small, the guide wire is less stiff and the operability of the guide wire may be reduced. Moreover, if the outer diameter is too large, the inside of the stomach may be damaged by the guide wire.

The second needle portion 42 has an opening communicating with the hollow portion 43 on the distal end side (the lower side in FIG. 20).
The outer diameter of the second needle portion 42 maintains a constant outer diameter from the proximal end to the vicinity of the distal end, and a sharp blade edge is formed at the tip. The shape of the second needle portion 42 can be the shape of the suture grasping needle 701 in the first embodiment (FIG. 4), for example. By doing so, in the second needle portion 42, the lateral hole communicating with the outside can be surely directed to the first needle portion 32. Further, the suture traction tool and the guide wire can be smoothly slid from the hollow portion 43 to the outside of the second needle portion 42.

Although the outer diameter of the 2nd needle part 42 is not specifically limited, For example, they are 12G or more and 22G or less, Preferably they can be 16G or more and 18G or less. By doing so, the suture traction tool and the guide wire can be easily and simultaneously inserted into the suture grasping needle 4, and the guide wire can be inserted into the living body together with the suture.
Although the full length of the 2nd needle part 42 is not specifically limited, For example, 20 mm or more and 200 mm, Preferably it can be 80 mm or more and 100 mm or less. If the overall length is too short, it may be buried in the patient's abdominal wall. Moreover, when the total length is too long, the operability of the medical instrument may be deteriorated.

  FIG. 21 is a front view showing the configuration of the suture traction tool 5. As shown in FIG. 21, the suture traction tool 5 includes a rod-shaped portion 52, a handle portion 51 provided on the proximal end side (upper side in FIG. 21) of the rod-shaped portion 52, and an annular portion 53 provided on the distal end side. And have. The suture traction tool 5 has a function of gripping the suture thread inserted from the suture insertion needle 3 within the internal tissue and pulling it to the body surface. Thereby, a body surface part and an internal tissue can be sutured easily.

The suture traction tool 5 according to the present embodiment and the third embodiment corresponds to the suture traction tool 710 (FIG. 1) in the medical device described in the first embodiment. The annular portion 53 corresponds to the snare 712 (FIG. 2 b) in the medical instrument described in the first embodiment.

  The handle portion 51 is substantially a rectangular parallelepiped, and the inner surface thereof is cut out into a substantially cylindrical shape. The handle portion 51 can come into contact with the proximal end surface of the contact portion 412 of the second hub 41 of the suture grasping needle 4.

The outer diameter of the rod-like portion 52 is configured to be smaller than the inner diameter of the suture grasping needle 4. Although the outer diameter of the rod-shaped part 52 is not specifically limited, For example, it is 0.3 mm or more and 0.8 mm or less, Preferably it can be 0.5 mm or more and 0.6 mm or less. If the outer diameter is too small, the strength of the suture traction tool 5 may not be sufficiently secured. If the outer diameter is too large, it may be difficult to insert the guide wire.
Although the length of the rod-shaped part 52 is not specifically limited, For example, 45 mm or more and 225 mm or less, Preferably, it is 105 mm or more and 125 mm or less. If the length is too short, the annular portion 53 may not sufficiently protrude from the distal end side (the lower side in FIG. 20) of the needle portion 42 of the thread grasping puncture needle 4, and the suture portion may not be grasped by the annular portion 53. is there. On the other hand, if the length is too long, the suture thread coming out from the distal end side (lower side in FIG. 19) of the first needle portion 32 of the suture insertion needle 3 is surely inserted into the annular portion 53 of the suture traction tool 5. There is a possibility that it will not be.

  The operability when the suture traction tool 5 and the guide wire are simultaneously inserted into the suture grasping needle 4 includes the outer diameter of the rod-like portion 52 and the outer diameter of the guide wire, and the inner diameter of the suture grasping needle 4. Depending on the clearance (gap distance), the inner diameter of the puncture needle 4 for grasping the thread, the outer diameter of the rod-like portion 52 of the suture traction tool 5 and the guide so that the clearance is, for example, 0.05 mm or more and 0.30 mm or less. Can be combined with the outer diameter of the wire. By doing so, the operability can be improved reliably.

  The annular portion 53 is deformed and substantially linear in the thread grasping puncture needle 4, and is annular when projecting from the thread grasping puncture needle 4. Thereby, the suture can be easily grasped. Therefore, it is preferable that the material forming the annular portion 53 has elasticity as described later.

  As shown in FIGS. 17 and 21, the medical instrument protrudes from the suture grasping needle 4 so that the central axis of the suture insertion needle 3 or its extension line penetrates the inside of the annular portion 53. It is formed to do. Thereby, the suture can be securely grasped.

  The diameter of the annular portion 53 is not particularly limited, but when the distance between the suture insertion needle 3 and the suture grasping needle 4 is L (mm), the diameter of the annular portion 53 is, for example, 1.5 L or more 3 It can be formed to be 0.0 L or less (mm). By doing so, the suture can be gripped more reliably.

  The wire diameter of the annular portion 53 is not particularly limited, but may be, for example, 0.1 mm to 0.3 mm, preferably 0.14 mm to 0.24 mm. If the wire diameter is too small, when a highly viscous body fluid adheres to the annular portion 53, it may be difficult to deform into a deformed state (straight state) and an annular state. If the wire diameter is too large, the suture traction tool 5 and the guide wire may not be simultaneously inserted into the suture grasping needle 4.

  Next, an example of how to use the medical instrument 1 will be described with reference to FIGS. 22 to 31 are front sectional views for explaining a method of using the medical instrument 1. The medical instrument 1 can be used according to the following procedures [1] to [11].

[1] Before using the medical instrument 1, first, an endoscope is inserted into the stomach of the patient, air is supplied sufficiently, and the abdominal wall 100 and the stomach wall 101 are brought into close contact with each other. Next, the position of the stomach is confirmed by transmitted light from the endoscope, the abdominal skin is disinfected, and local anesthesia is performed. Subsequently, a small incision is made at the site with a scalpel.
[2] The abutment member 23 of the main body 2 is brought into contact with the abdominal wall 100, and the suture grasping needle 4 is punctured almost vertically from the small incision site into the abdominal wall 100 and the stomach wall 101 of the patient (FIG. 22).
[3] The handle portion 51 of the suture traction tool 5 is operated, and the suture traction tool 5 is inserted into the hollow portion 43 of the suture grasping needle 4 until the lower end of the handle portion 51 contacts the second hub 41. insert. Thereby, the annular portion 53 of the suture traction tool 5 protrudes from the tip of the suture grasping needle 4 and spreads in an annular shape (FIG. 23). When inserting the suture traction tool 5 into the suture grasping needle 4, the suture traction tool 5 is previously stored in the suture grasping needle 4 and the operation [2] is performed. Also good.
[4] Next, the thread insertion puncture needle 3 is punctured almost perpendicularly to the abdominal wall and stomach wall of the patient through the fixing member 22 and the contact member 23. At this time, the thread insertion puncture needle 3 passes through the inside of the annular portion 53 of the suture traction tool 5 (FIG. 24).
In this method of use, it is not necessary to puncture the suture insertion needle 3 and the suture grasping needle 4 simultaneously. Since the puncture needles can be punctured separately, the puncture needle can be punctured more easily than when puncturing two at the same time.
[5] The suture thread 102 is inserted into the hollow portion 33 of the thread insertion puncture needle 3, and the suture thread 102 is projected from the tip of the thread insertion puncture needle 3 (FIG. 25). At this time, since the suture insertion needle 3 passes through the inside of the annular portion 53, the suture thread 102 also passes through the inside of the annular portion 53.
[6] Next, while maintaining the main body 2 and the thread grasping puncture needle 4 as they are, only the thread insertion puncture needle 3 is pulled out from the fixing member 22 to the proximal end side (upper side in FIG. 26) (FIG. 26). 26). At this time, the protruding portion of the suture thread 102 can be lengthened. In this way, the suture thread 102 can be prevented from being pulled out. Further, the suture insertion needle 3 can be pulled out while feeding the suture thread 102. As a result, the suture thread 102 passes through the inside of the annular portion 53. At this time, the suture traction tool 5 can be pulled up to confirm that the suture 102 is gripped.
[7] The main body 2 is rotated by approximately 180 ° using the suture grasping needle 4 as a rotation axis (FIG. 27). As a result, the suture thread 102 is removed from the fixing member 22 and the contact member 23 through the first notch 2223 of the fixing member 22. Note that the suture 102 does not come out of the inside of the annular portion 53.
[8] After rotation, the thread insertion puncture needle 3 is punctured almost perpendicularly to the abdominal wall and stomach wall of the patient through the fixing member 22 and the contact member 23 again. At this time, the thread insertion puncture needle 3 passes through the inside of the annular portion 53 of the suture traction tool 5 in the same manner as the operation of FIG. Then, the suture thread 102 is inserted into the hollow portion 33 of the thread insertion puncture needle 3, and the suture thread 102 is projected from the tip of the thread insertion puncture needle 3 (FIG. 28). As a result, the two sutures 102 are arranged inside the annular portion 53.
[9] Next, the suture traction tool 5 is slightly pulled upward. At this time, since the two sutures 102 are arranged inside the annular part 53, the annular part 53 enters the lumen of the suture grasping needle 4 by pulling up the suture traction tool 5, and the two sutures 102. The suture thread 102 is gripped (FIG. 29).
[10] Then, the guide wire 103 is inserted from the side port 413 of the hub 41 of the suture grasping needle 4 (FIG. 30). The order of inserting the guide wire is not particularly limited as long as it is after puncturing the suture grasping needle 4.
[11] The two sutures 102 are grasped by the suture traction tool 5, and the main body 2 is pulled up from the abdominal wall 100 with the suture insertion needle 3 attached to the main body 2. By these operations, the suture thread 102 inserted from the two puncture positions where the thread insertion puncture needle 3 is inserted passes through the stomach wall 101 from the abdominal wall 100 and protrudes from the position where the suture grasping needle 4 is punctured. (FIG. 31). Further, the guide wire 103 is inserted in the position where the suture grasping needle 4 is punctured. Then, the end of the suture thread 102 is ligated to fix the abdominal wall 100 and the stomach wall 101.
As described above, the medical instrument 1 has the thread insertion puncture needle 3 and the thread grasping puncture needle 4 detachable from the main body 2. The stomach wall 101 can be securely sutured with the two sutures 102.

  In the above description, the case where the thread insertion puncture needle 3 and the thread grasping puncture needle 4 are punctured separately has been described. However, the method of using the medical instrument 1 is not limited to this, and two puncture needles are used. Can be punctured simultaneously. In that case, the first flange 311 of the suture insertion needle 3 and the first flange engaging portion 225 of the first fixing portion 221 are engaged, and the second flange 411 of the suture grasping needle 4 is engaged. And the second flange engaging portion 227 of the second fixing portion 222 can be engaged with each other.

(Third embodiment)
The medical instrument described in the first or second embodiment may be configured to have a plurality of suture insertion needles. Hereinafter, the case where the medical instrument described in the second embodiment has two puncture needles will be described as an example.

  FIG. 32 is a perspective view showing a configuration of the medical instrument 11 according to the present embodiment. As shown in FIG. 32, the main body 2, the thread insertion puncture needle 3 supported by the main body 2 and capable of inserting a suture, the thread insertion puncture needle (third puncture needle) 6, and the thread insertion puncture needle 3 and a thread insertion puncture needle 6, which is provided close to the thread insertion puncture needle 6 and into which a suture traction tool can be inserted. The thread insertion puncture needle 3, the thread insertion puncture needle 6, and the thread grasping puncture needle 4 are detachably attached to the main body 2 by an attaching / detaching means.

This medical instrument 11 is configured such that a thread insertion puncture needle 6 can be further attached to and detached from the main body 2 of the medical instrument 1 (FIG. 17) described in the second embodiment. About each other component, the thing of the medical instrument 1 mentioned above can be applied as it is, for example.
Hereinafter, each component of the medical instrument 11 will be described focusing on differences from the medical instrument 1 described in the second embodiment.

FIG. 33 is a front view showing the configuration of the main body 2 of the medical instrument 11. The main body 2 has a function of supporting the suture insertion needle 3, the suture grasping needle 4, and the suture insertion needle 6.
The main body 2 includes a support member 21, a fixing member 22 provided on the base end side (upper side in FIG. 33) of the support member 21, and a contact member 23 provided on the distal end (lower side in FIG. 33). is doing.
The fixing member 22 has a function of fixing the suture insertion needle 3, the suture grasping needle 4, and the suture insertion needle 6.

As shown in FIG. 33, the fixing member 22 includes a first fixing portion 221, a second fixing portion 222 and a second fixing portion 222 that fix the thread insertion puncture needle 3, the thread grasping puncture needle 4 and the thread insertion puncture needle 6. 3 fixing portions 2231 and a plate-like body 223, which are integrally formed.
The first fixing portion 221, the second fixing portion 222, and the third fixing portion 2231 are provided in a substantially straight line on the base end side (upper side in FIG. 33) of the plate-like body 223. .

  The 1st fixing | fixed part 221, the 2nd fixing | fixed part 222, and the 3rd fixing | fixed part 2231 have a substantially the same structure, and each shape is a substantially rectangular parallelepiped. Further, the heights of the first fixing portion 221 and the third fixing portion 2231 are higher than those of the second fixing portion 222. Thereby, each fixing | fixed part can be identified easily visually. In the present embodiment, the heights of the first fixing portion 221 and the third fixing portion 2231 are different from the height of the second fixing portion 222, but may be the same height.

  The third fixing portion 2231 is provided with a third recess 2234 into which the thread insertion puncture needle 6 can be inserted.

The third recess 2234 has a third flange engagement with a third flange (not shown in FIGS. 32 and 33) of a third hub 61 (described later) provided on the puncture needle 6 for thread insertion. A joining portion 2232 is formed.
The third recess 2234 is hollowed out in a columnar shape, and the diameter on the distal end side is small and the diameter on the proximal end side is large with the third flange engaging portion 2232 as a boundary. The third concave portion 2234 is open to the front side of the third fixing portion 2231, and a third hub 61 of the suture insertion needle 6 described later can be inserted from the front side portion.

  The third flange engaging portion 2232 can be engaged with a third flange 611 which will be described later with reference to FIG. In a state where the third flange 611 is engaged with the third flange engaging portion 2232, the suture insertion needle 6 does not rotate or move up and down.

  Further, the thread insertion puncture needle 6 can be inserted into the third recess 2234 from the proximal end side without engaging the third flange 611 with the third flange engaging portion 2232. Also in this case, the outer periphery of the third flange 611 fits into the third recess 2234 and is restricted, so that the rotation does not move up and down.

  The third fixing portion 2231 is formed with a third notch 2233 so that the suture insertion needle 6 can be attached and detached. Thereby, the thread insertion puncture needle 6 can be attached and detached. For this reason, workability | operativity can be improved. The third notch 2233 is formed from the front side flange of the fixing member 22 to the inside of the third recess 2234 via the third fixing portion 2231.

  As shown in FIGS. 32 and 33, the abutting member 23 has a flat plate shape, and has a first cylindrical portion 231 having a lumen into which the thread insertion puncture needle 3 can be inserted, on the base end side surface, A second cylindrical portion 232 having a lumen into which the thread grasping puncture needle 4 can be inserted, and a third cylindrical portion 2335 having a lumen into which the thread insertion puncture needle 6 can be inserted are provided. The contact member 23 has a function of improving stability when the medical device 11 is used by contacting the body surface portion.

  The first cylindrical portion 231, the second cylindrical portion 232, and the third cylindrical portion 2335 are used when puncturing the thread insertion puncture needle 3, the thread grasping puncture needle 4, and the thread insertion puncture needle 6, respectively. It has a function to improve the stability of.

  The abutting member 23 has a first attaching / detaching means so that the thread inserting puncture needle 3, the thread grasping puncture needle 4, and the thread inserting puncture needle 6 can be attached to and detached from the contact member 23. Are provided with a second notch 233, a second notch 234, and a third notch 236. Thereby, the thread insertion puncture needle 3, the thread gripping puncture needle 4, and the thread insertion puncture needle 6 can be attached and detached, thereby improving workability.

  The first notch 233, the second notch 234, and the third notch 236 are respectively formed from the flange portion of the contact member 23 to the first cylindrical portion 231, the second cylindrical portion 232, and the third cylindrical portion. 2335 is formed to the inside of the cylinder. Thus, the thread insertion puncture needle 3, the thread gripping puncture needle 4, and the thread insertion puncture needle 6 can be attached to and detached from the contact member 23.

  FIG. 34 is a view showing the front and cross section of the suture insertion needle 6. As shown in FIG. 34, the suture insertion needle 6 has a third hub 61 provided on the proximal end side (upper side in FIG. 34) and a third needle portion 62 provided on the distal end side. is doing. The thread insertion puncture needle 6 has a function of inserting a suture into the internal tissue in the same manner as the thread insertion puncture needle 3.

  The third hub 61 and the third needle portion 62 have a hollow portion 63 and are used as a suture passage. The hollow portion 63 in the third hub 61 has an inner diameter that gradually decreases from the proximal end side toward the distal end side.

In the present embodiment, the third hub 61 corresponds to the stopper 719 (FIG. 3) in the medical instrument described in the first embodiment.
The third hub 61 has a substantially columnar shape, and has a third flange 611 that can be engaged with the third flange engaging portion 2232 on the distal end side thereof.

  The third needle portion 62 has an opening communicating with the hollow portion 63 on the distal end side (lower side in FIG. 34). The third needle portion 62 maintains a constant outer diameter from the proximal end to the vicinity of the distal end, and a sharp needle tip is formed at the tip.

  The configuration of the first needle portion 32 can be applied to the configuration of the third needle portion 62. The shape of the third needle portion 62 can be the shape of the suture insertion needle 715 (FIG. 4) in the first embodiment, for example. By doing so, in the third needle portion 62, the lateral hole communicating with the outside can be surely directed to the second needle portion. In addition, the suture can be inserted smoothly.

Although the outer diameter of the 3rd needle part 62 is not specifically limited, For example, it is 15G or more and 25G or less, Preferably it can be 19G or more and 21G or less. By doing so, the puncture resistance of the thread insertion puncture needle 6 can be reduced. For this reason, puncture into the body is easy.
Although the full length of the 3rd needle part 62 is not specifically limited, For example, it is 20 mm or more and 200 mm or less, Preferably it can be 80 mm or more and 100 mm or less. If the total length is too long, the patient may be buried in the patient's abdominal wall. If the total length is too long, the operability of the medical instrument 11 may be reduced.

  Next, another method of using the medical instrument 11 will be described. As described above, each component of the medical instrument 1 is basically applied to the medical instrument 11 as it is, so that the thread insertion needle 6 can be further attached to and detached from the main body 2 of the medical instrument 1. It is configured. For this reason, when using the medical instrument 11, the use procedure of the medical instrument 1 can be taken in. Therefore, the following description will focus on differences from the procedures described in [1] to [11] above.

[12] First, the operations [1] to [5] using the above-described medical instrument 1 are similarly performed.
[13] Next, with the main body 2, the suture insertion needle 3 and the suture grasping needle 4 being in the same state, the handle portion 51 of the suture traction tool 5 is operated to move the suture traction tool 5 to 180. Rotate. Note that the suture 102 does not come out of the inside of the annular portion 53. At this time, in order to prevent the suture 102 from being pulled out, the protruding portion of the suture 102 can be lengthened.
[14] Next, the thread insertion puncture needle 6 is punctured almost perpendicularly to the abdominal wall and stomach wall of the patient through the fixing member 22 and the contact member 23 . At this time, the thread insertion puncture needle 6 is allowed to pass through the inside of the annular portion 53 of the suture traction tool 5 as in the operation of FIG. Then, the suture thread 102 is inserted into the hollow portion 63 of the thread insertion puncture needle 6, and the suture thread 102 is projected from the tip of the thread insertion puncture needle 6. As a result, the two sutures 102 are arranged inside the annular portion 53.
Even in this method of use, it is not necessary to puncture the thread insertion puncture needle 3, the thread grasping puncture needle 4 and the thread insertion puncture needle 6 simultaneously. That is, since the puncture needles can be punctured separately, it is possible to puncture more easily than when two puncture needles are punctured simultaneously.
[15] Next, the suture traction tool 5 is slightly pulled upward. At this time, since the two sutures 102 are arranged inside the annular part 53, the annular part 53 enters the lumen of the suture grasping needle 4 by pulling up the suture traction tool 5, and the two sutures 102 are inserted. The suture thread 102 is gripped.
[16] Then, the guide wire 103 is inserted from the side port 413 of the hub 41 of the suture grasping needle 4. The order of inserting the guide wire is not particularly limited as long as it is after puncturing the suture grasping needle 4.
[17] The two sutures 102 are grasped by the suture traction tool 5, and the main body 2 is pulled up from the abdominal wall 100 with the thread insertion puncture needle 3 and the thread insertion puncture needle 6 attached to the main body 2. By these operations, the suture thread 102 inserted from the two puncture positions where the thread insertion puncture needle 3 and the thread insertion puncture needle 6 are inserted passes through the stomach wall 101 from the abdominal wall 100 and the thread grasping puncture needle 4 is moved. It will be in the state protruded from the puncture position. Further, the guide wire 103 is inserted in the position where the suture grasping needle 4 is punctured. Then, the end of the suture thread 102 is ligated to fix the abdominal wall 100 and the stomach wall 101.

As described above, by using the medical instrument 11, the abdominal wall 100 and the stomach wall 101 can be sutured more reliably with the two sutures 102.
As mentioned above, although the medical instrument of this invention was demonstrated based on embodiment, this invention is not limited to this.

  For example, the shape of the support member, the fixing member, the contact member, etc. of the main body, the structure of the attaching / detaching means, the shape of the hub of each puncture needle, and the like may be different from the above-described embodiments. Specifically, for example, a hole into which the guide wire 103 can be inserted may be provided on the upper surface of the handle portion 51. If the hole communicates with the hollow portion 43 in the second hub 41, the suture traction tool 5 and the guide wire 103 can be easily inserted into the suture grasping needle 4 simultaneously. The hole into which the guide wire 103 provided in the handle portion 51 can be inserted may be formed in any portion of the handle portion 51.

Further, the suture grasping needle 4 or the suture grasping needle 701 may have two or more lumens. In this case, the suture traction tool 5 and the guide wire 103 are simultaneously attached to the suture grasping needle 4. Insertion can be achieved easily.
Moreover, the use location to the living body is not limited to the abdominal wall and stomach wall, and for example, it can be used for lifting each built-in wall, blood vessel, nerve, etc. to the abdominal wall.

Claims (20)

(A) A hollow puncture needle having a sharp tip and not penetrating through the tip, having a lateral hole in the vicinity of the tip, and used by inserting a suture thread into the hollow portion Puncture needle,
(B) It is a hollow puncture needle that is arranged substantially parallel to the lateral direction of the thread insertion puncture needle, has a sharp tip, and does not penetrate the tip, and has a lateral hole near the tip.
A suture grasping puncture needle used by inserting the suture thread into the hollow portion;
(C) a suture traction tool slidably inserted into the hollow portion of the suture grasping puncture needle;
(D) a fixing member that relatively determines the tip positions of the thread insertion puncture needle and the thread grasping puncture needle; and (e) the thread insertion puncture needle and the thread grasping puncture needle that are supported and sutured. A contact member that contacts the object,
And it has a,
A medical instrument, wherein the contact member is provided with a notch configured to be able to remove the suture from the buttock of the contact member . 2. The medical instrument according to claim 1 , wherein the suture traction tool has a snare whose tip is formed of an elastically deformable material, and an extension line of the puncture needle for insertion of the thread is in the free state. A medical instrument that extends so as to pass through the inside of the snare and can be stored in the hollow portion of the suture grasping needle in an elastically deformed state. 3. The medical instrument according to claim 1 , wherein the contact member supports the thread insertion puncture needle and the thread grasping puncture needle substantially in parallel with each other. . The medical instrument according to any one of claims 1 to 3 , wherein the fixing member is provided on the suture grasping puncture needle, and the distal end position of the suture insertion needle with respect to the distal end position of the suture grasping puncture needle A medical instrument characterized in that it can be determined at an arbitrary position. The medical instrument according to any one of claims 1 to 4 , wherein the notch is formed from a collar portion of the abutting member to a holding position of the suture insertion needle . Instruments. The medical instrument according to any one of claims 1 to 5 , wherein the edge of the lateral hole of the suture insertion needle and the edge of the lateral hole of the suture grasping needle are chamfered or rounded. A medical instrument characterized by being. 7. The medical instrument according to claim 1 , wherein at least one of the thread insertion puncture needle and the thread grasping puncture needle is detachably supported by the contact member. A medical instrument characterized. The apparatus according to any one of claims 1 to 7, having a puncture needle for a plurality of said yarn insertion, the yarn grasping needle is proximate to each of said plurality of said yarn insertion needle A medical instrument characterized by being provided. A medical instrument used for suturing a body surface part and an internal tissue,
The body,
A thread insertion puncture needle supported by the body and capable of inserting a suture;
A suture grasping puncture needle provided close to the suture insertion puncture needle and having a hollow portion into which a suture traction tool can be slidably inserted;
Have
At least one of the suture insertion needle and the suture grasping needle is detachably attached to the main body,
The body is
A fixing member provided at a rear end of the thread insertion puncture needle or the thread grasping puncture needle, and fixing the distal end of the thread insertion puncture needle or the distal end of the thread grasping puncture needle to a predetermined position;
A support member for supporting the fixing member;
A contact member that is provided on the distal end side of the support member and contacts the body surface portion, and supports the thread insertion puncture needle and the thread grasping puncture needle;
Have
The support member supports the fixing member and the contact member, and supports the thread insertion puncture needle and the thread grasping puncture needle through the contact member. Medical instrument. 10. The medical use according to claim 9, wherein a position for fixing the suture insertion puncture needle and a position for fixing the suture grasping puncture needle are provided symmetrically with respect to the support member. Instruments. The medical instrument according to claim 9 or 10,
  A medical instrument characterized in that heights of the rear ends of the thread insertion puncture needle and the thread grasping puncture needle respectively fixed to the fixing member are different. The medical device according to any one of claims 9 to 11,
The fixing member is
An engagement portion for inserting the thread insertion puncture needle and the thread grasping puncture needle from the side of the main body, respectively, and fixing rotation and vertical movement with the main body;
A recess for inserting the suture insertion needle and the suture grasping needle from the proximal end side of the fixing member, respectively.
A medical instrument characterized by having both . The medical instrument according to any one of claims 9 to 12 , wherein the fixing member has a notch that allows the thread insertion puncture needle or the thread grasping puncture needle to be detachable from the main body. Medical instrument to do. The medical instrument according to any one of claims 9 to 13 , wherein the contact member has a notch that allows the thread insertion puncture needle or the thread gripping puncture needle to be detachable from the main body. Medical instrument. The medical instrument according to claim 13, wherein the notch is formed inside from a side edge of the fixing member. The medical instrument according to claim 14, wherein the cutout portion is formed inside from a collar portion of the contact member. 17. The medical instrument according to claim 9 , wherein the thread insertion puncture needle and the thread grasping puncture needle are configured to be able to puncture independently. The medical instrument according to any one of claims 9 to 17 , wherein the thread insertion puncture needle and the thread grasping puncture needle are punctured and the main body is in contact with the body surface portion. A medical instrument configured to be able to remove an insertion puncture needle independently. The medical instrument according to any one of claims 9 to 18, wherein the main body is configured to be rotatable about the thread grasping puncture needle as a rotation axis. The apparatus according to any of claims 9 to 19, having a puncture needle for a plurality of said yarn insertion, the yarn grasping needle is proximate to each of said plurality of said yarn insertion needle A medical instrument characterized by being provided.

Images